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DC 7329 · 38 CFR 4.114

Large Intestine Resection C&P Exam Prep

To document the current severity of your large intestine resection and any resulting complications, including stoma status, bowel function, nutritional status, and impact on daily functioning, so that VA can assign an accurate disability rating under DC 7329.

Format:
Interview + Physical
Typical duration:
20-30 minutes
DBQ form:
intestines (intestines)
Examiner:
Gastroenterologist or Physician

What the examiner evaluates

  • Extent of large intestine removed (partial vs. total colectomy)
  • Presence and type of stoma (permanent colostomy or ileostomy)
  • Whether reanastomosis was performed and outcomes thereof
  • High-output syndrome and episodes of dehydration requiring IV hydration
  • Frequency and character of bowel movements and diarrhea
  • Loss of ileocecal valve
  • Nutritional status including need for TPN or tube feeding
  • BMI and weight loss / wasting
  • Peritoneal adhesions and complications
  • Presence of fistulous disease
  • Systemic manifestations such as anemia, weakness, fatigue
  • Current medications and dietary management requirements
  • Hospitalizations and emergency treatments in the past 12 months
  • Impact on ability to work and activities of daily living

Exam may be conducted in person or via telehealth. If telehealth, the examiner must document how the examination was conducted. Bring all surgical records, operative reports, pathology reports, and recent lab work if available. Arrive having tracked your bowel movement frequency, stoma output, and any recent hospitalizations.

Measurements and tests

BMI Calculation

What it measures: Body Mass Index, used to assess nutritional status and undernutrition severity

What to expect: The examiner will record your current height and weight and calculate your BMI. This directly affects rating thresholds.

Critical thresholds

  • BMI < 16 Supports highest nutritional deficiency rating level
  • BMI 16-18 inclusive Supports significant nutritional deficiency rating level
  • BMI > 18 Less likely to support nutritional deficiency-based rating elevation

Tips

  • Weigh yourself consistently (same time of day, before eating) in the weeks prior to accurately report your weight trend
  • Report any unintentional weight loss since surgery or in the past 6-12 months
  • Note if your weight fluctuates due to dehydration episodes

Pain considerations: N/A - weight-bearing not applicable for this measurement

Complete Blood Count (CBC)

What it measures: Hemoglobin, hematocrit, white blood cell count, and platelets - used to identify anemia, infection/inflammation, and systemic complications

What to expect: Blood draw may be ordered or prior lab results reviewed. The examiner will document hemoglobin, hematocrit, WBC, and platelet values.

Critical thresholds

  • Low hemoglobin / hematocrit Supports anemia related to malabsorption; may elevate rating
  • Elevated WBC Supports leukocytosis / systemic infection finding

Tips

  • Bring copies of any recent bloodwork from your treating physician
  • Note if you have been diagnosed with iron-deficiency or B12-deficiency anemia since the resection
  • Inform the examiner of any IV iron infusions or B12 injections you receive

Pain considerations: N/A

Stoma Output Assessment

What it measures: Volume and frequency of ostomy output, used to evaluate high-output syndrome

What to expect: The examiner will ask about daily stoma output volume, consistency, and any need for pad changes or pouching system upgrades.

Critical thresholds

  • High-output syndrome (generally >1500 mL/day ostomy output) Critical for 100% rating when combined with total colectomy and 2+ dehydration episodes requiring IV hydration
  • Daily discharge requiring pad changes Supports higher rating within colostomy/ileostomy categories

Tips

  • Keep a log of daily ostomy output volume for at least 2 weeks before the exam
  • Document how often you change your pouch or appliance daily
  • Note any episodes of leakage, skin breakdown (peristomal dermatitis), or need for emergency pouch changes

Pain considerations: N/A

Dehydration Episode Tracking

What it measures: Number of episodes in the past 12 months requiring intravenous hydration for dehydration

What to expect: The examiner will ask specifically how many times you required IV fluids for dehydration at an emergency department, urgent care, or hospital in the past year.

Critical thresholds

  • More than 2 episodes requiring IV hydration in past 12 months Required criterion for 100% rating under DC 7329 when combined with total colectomy, ileostomy, and high-output syndrome

Tips

  • Gather all ER records, hospital discharge summaries, and treatment notes documenting IV hydration visits
  • Count visits accurately - do not undercount or overcount
  • Note dates, locations, and duration of each hospitalization or ER visit

Pain considerations: N/A

Bowel Movement Frequency Log

What it measures: Number and character of bowel movements per day, used for rating diarrhea severity and post-reanastomosis outcomes

What to expect: Examiner will ask about daily bowel movement frequency, urgency, consistency, presence of blood or mucus, and ability to control defecation.

Critical thresholds

  • More than 3 episodes of diarrhea per day Required for 20% rating under partial colectomy with reanastomosis and loss of ileocecal valve
  • 4 or more episodes of diarrhea per day Supports higher rating consideration and functional impact documentation

Tips

  • Keep a bowel diary for at least 2 weeks before the exam recording number, time, urgency, and consistency of each movement
  • Document your worst days, not just average days
  • Note any episodes of fecal incontinence or explosive/unpredictable bowel movements

Pain considerations: Note if bowel movements are associated with pain, cramping, or significant urgency that limits your ability to leave home or work

Rating criteria by percentage

100%

Total colectomy with formation of ileostomy, high-output syndrome, AND more than two episodes of dehydration requiring intravenous hydration in the past 12 months. All three elements must be present.

Key symptoms

  • Total colectomy with ileostomy
  • High-output syndrome (excessive stoma output causing fluid and electrolyte imbalance)
  • More than 2 separate episodes of dehydration requiring IV hydration in the past 12 months
  • Significant nutritional compromise
  • Weight loss and wasting
  • Weakness and fatigue
  • Potential requirement for TPN

From 38 CFR: Total colectomy with formation of ileostomy, high-output syndrome, and more than two episodes of dehydration requiring intravenous hydration in the past 12 months.

60%

Total colectomy with or without permanent colostomy or ileostomy, without high-output syndrome.

Key symptoms

  • Total colectomy confirmed by surgical records
  • Permanent colostomy or ileostomy present OR reanastomosis performed
  • No high-output syndrome OR high-output syndrome controlled
  • Altered bowel function
  • Dietary modifications required
  • Possible nutritional supplementation required
  • Ongoing fatigue and weakness

From 38 CFR: Total colectomy with or without permanent colostomy or ileostomy without high-output syndrome.

40%

Partial colectomy with permanent colostomy or ileostomy, without high-output syndrome.

Key symptoms

  • Partial colectomy (not total removal)
  • Permanent colostomy or ileostomy present
  • No high-output syndrome
  • Ongoing stoma management needs
  • Dietary restrictions
  • Possible skin complications around stoma
  • Activity limitations due to stoma

From 38 CFR: Partial colectomy with permanent colostomy or ileostomy without high-output syndrome.

20%

Partial colectomy with reanastomosis (reconnection of intestinal tube) with loss of ileocecal valve AND recurrent episodes of diarrhea more than 3 times per day.

Key symptoms

  • Partial colectomy with surgical reconnection of bowel
  • Loss of ileocecal valve documented
  • Recurrent diarrhea more than 3 times per day
  • Urgency and unpredictability of bowel movements
  • Possible nutritional deficiencies (B12, fat-soluble vitamins, bile salt malabsorption)
  • Abdominal cramping and pain
  • Explosive or watery bowel movements

From 38 CFR: Partial colectomy with reanastomosis (reconnection of the intestinal tube) with loss of ileocecal valve and recurrent episodes of diarrhea more than 3 times per day.

10%

Partial colectomy with reanastomosis (reconnection of the intestinal tube) without the additional findings required for a higher rating.

Key symptoms

  • Partial colectomy with bowel reconnection
  • Ileocecal valve preserved OR diarrhea not exceeding 3 times per day
  • Mild to moderate bowel irregularity
  • Dietary modifications may be needed
  • Some change in stool frequency or form
  • Possible mild abdominal discomfort or bloating

From 38 CFR: Partial colectomy with reanastomosis (reconnection of the intestinal tube).

Describing your symptoms accurately

Bowel Movement Frequency and Urgency

How to describe it: Describe the exact number of bowel movements or stoma evacuations per day on both average and worst days. Specify whether movements are watery, loose, or formed, and whether you have urgency, accidents, or explosive movements that are difficult to predict or control. Quantify how this limits you - e.g., 'I cannot leave home for more than 90 minutes without risking an accident' or 'I have to plan all outings around bathroom access.'

Example: On my worst days, I have 6-8 watery bowel movements before noon, with no warning. I have had multiple accidents in public. I cannot travel, attend appointments, or work a full shift because I cannot be more than 30 feet from a bathroom at all times. The urgency wakes me from sleep 2-3 times per night.

Examiner listens for: Specific frequency counts, urgency severity, nocturnal awakening for bowel movements, fecal incontinence episodes, and functional limitations caused by unpredictability.

Avoid: Do not say 'I go to the bathroom a lot' - give numbers. Do not minimize accidents or urgency to avoid embarrassment. Do not report only your best days.

Stoma Management and Complications

How to describe it: For veterans with a colostomy or ileostomy, describe daily stoma care burden, approximate output volume, frequency of pouch changes, and any complications such as skin breakdown, peristomal hernia, prolapse, retraction, leakage, or odor. Describe how the stoma affects your ability to work, exercise, be intimate, travel, and participate in social activities.

Example: My stoma output can exceed 2 liters per day during flares. I change my pouch 4-5 times daily and still have leakage. The skin around my stoma is constantly raw and painful, requiring prescription barrier cream. I cannot wear certain clothing, cannot swim, cannot travel by air, and I have had to leave work early multiple times due to pouch failures.

Examiner listens for: Output volume estimates, pouch change frequency, skin complications, parastomal hernia, need for specialist ostomy nursing, and psychosocial impact of permanent stoma.

Avoid: Do not say 'I manage okay' without describing the daily time burden and complications. Do not omit skin breakdown or peristomal hernia. Do not understate the psychological impact.

Dehydration and Electrolyte Imbalances

How to describe it: Describe every episode in the past 12 months when you required IV fluids at an ER, urgent care, or hospital for dehydration. Provide dates, locations, duration of treatment, and symptoms that prompted each visit (e.g., dizziness, confusion, muscle cramps, inability to keep fluids down). Also describe ongoing daily symptoms of chronic dehydration such as constant thirst, dark urine, muscle cramps, and fatigue.

Example: I have been to the emergency room four times in the past year for IV fluids. Each time I was dizzy, unable to stand, had severe muscle cramping, and my sodium and potassium were critically low. Between visits, I am chronically dehydrated - I drink over 3 liters of oral rehydration solution daily and still feel parched and fatigued.

Examiner listens for: Exact count of IV hydration episodes in past 12 months, specific electrolyte abnormalities documented, whether hospitalizations were required, and whether oral rehydration is sufficient between episodes.

Avoid: Do not combine multiple-day hospital stays as 'one episode' if each was a separate admission. Do not omit urgent care IV hydration visits. Do not forget to mention chronic ongoing dehydration symptoms between acute episodes.

Nutritional Deficiencies and Weight Loss

How to describe it: Describe any documented nutritional deficiencies (iron, B12, vitamin D, calcium, fat-soluble vitamins), current BMI and weight relative to your pre-surgery weight, any need for prescribed dietary supplementation, enteral tube feeding, or total parenteral nutrition (TPN). Describe weakness, fatigue, hair loss, bone pain, or other symptoms attributable to malnutrition.

Example: I have lost 45 pounds since my surgery and my BMI is now 16.8. I require B12 injections monthly, iron infusions every 3 months, and prescription high-calorie oral supplements daily. On bad days, I am too weak to climb a flight of stairs. My doctor has discussed starting TPN if my weight continues to decline.

Examiner listens for: Documented BMI, specific deficiencies confirmed by lab work, prescribed supplementation regimen, weight loss trajectory, and functional weakness attributed to malnutrition.

Avoid: Do not say 'I take vitamins' without distinguishing between over-the-counter supplements and physician-prescribed supplementation for documented deficiencies. Do not omit weight loss amounts.

Abdominal Pain and Peritoneal Adhesions

How to describe it: Describe the location, character (cramping, sharp, constant, intermittent), severity (0-10 scale), and duration of abdominal pain. If you have peritoneal adhesions, describe episodes of partial obstruction, nausea, vomiting, and emergency visits. Note what activities worsen pain (eating, physical activity, stress) and what provides relief. Describe how pain limits your ability to eat normal meals, work, or perform daily activities.

Example: On my worst days, I have constant 8/10 cramping abdominal pain that begins within 30 minutes of eating anything. I have had three ER visits for suspected bowel obstruction from adhesions in the past 18 months. The pain prevents me from eating normal meals - I eat 5-6 very small portions daily to try to avoid triggering pain, but I still lose weight.

Examiner listens for: Pain frequency (intermittent vs. constant), relationship to eating, evidence of partial or complete obstruction from adhesions, and functional limitation on eating and activity.

Avoid: Do not say 'some discomfort' when you mean significant pain. Do not omit ER visits for obstruction. Report pain on your worst days, not only when currently comfortable.

Fatigue, Weakness, and Functional Impairment

How to describe it: Describe how fatigue and weakness from your large intestine resection affect your ability to perform work, household chores, recreational activities, and self-care. Quantify - e.g., 'I can only stand for 20 minutes before needing to rest' or 'I sleep 10-12 hours per night and still wake exhausted.' Connect fatigue to specific causes: anemia, malnutrition, dehydration, disrupted sleep from nocturnal bowel movements.

Example: My fatigue is debilitating on my worst days. I wake 3-4 times per night for bowel movements and am exhausted all day. I cannot work more than 4 hours before needing to lie down. I can no longer do yard work, exercise, or play with my grandchildren. My spouse handles most household tasks because I do not have the energy.

Examiner listens for: Connection between GI symptoms and fatigue (anemia, malnutrition, sleep disruption), specific functional limitations, and impact on work capacity and activities of daily living.

Avoid: Do not say 'I'm a little tired' - describe the severity and daily impact. Do not omit the nocturnal disruption from bowel movements.

Common mistakes to avoid

Reporting only average symptom days instead of worst days

Why: VA ratings are based on the full picture of disability, including your worst days. Reporting only 'typical' days can result in a rating that does not reflect your actual worst-case function.

Do this instead: Describe both your average day and your worst day explicitly. Say: 'On an average day I have 5 bowel movements, but on my worst days I have 10-12 and cannot leave my home.'

Impact: All levels - particularly the 20% vs. 40%+ distinction based on diarrhea frequency

Failing to document the exact number of IV hydration episodes in the past 12 months

Why: More than 2 IV hydration episodes is a specific threshold criterion for the 100% rating. Without documented proof and accurate reporting, you may not receive the highest rating even if you qualify.

Do this instead: Gather all ER records, admission records, and clinic notes documenting IV fluid administration. Present the exact count and dates to the examiner.

Impact: 100%

Not clearly distinguishing between partial and total colectomy

Why: The entire rating structure under DC 7329 depends on whether your resection was partial or total. If the examiner does not clearly document total vs. partial, you may be rated at a lower tier.

Do this instead: Bring your operative report and any pathology reports confirming the extent of resection. Tell the examiner explicitly: 'I had a total colectomy' or 'I had a partial colectomy removing X portion of my colon.'

Impact: 60% vs. 40% and 100% vs. 60%

Omitting the loss of ileocecal valve when it was removed

Why: Loss of the ileocecal valve is a specific criterion that differentiates the 20% rating from the 10% rating in partial colectomy with reanastomosis cases.

Do this instead: Review your operative report to confirm whether the ileocecal valve was preserved or removed. Inform the examiner specifically about valve loss and its consequences (increased diarrhea, B12 malabsorption, bile salt issues).

Impact: 10% vs. 20%

Downplaying stoma complications or daily management burden

Why: The functional burden of stoma care - including skin breakdown, leakage, output volume, and social/occupational impact - directly informs the overall severity determination and functional impact sections of the DBQ.

Do this instead: Describe all peristomal skin problems, frequency and reasons for appliance changes, and every way the stoma limits your daily life, employment, and social activities.

Impact: 40% and 60%

Failing to mention peritoneal adhesions as a separate complicating condition

Why: Peritoneal adhesions (DC 7301) can be rated separately or contribute to the overall picture of disability. If not mentioned, the examiner may not check the relevant DBQ fields or recommend a separate evaluation.

Do this instead: Report any episodes of partial bowel obstruction, bowel obstruction pain, or hospitalizations attributable to adhesions. Ask your VSO or attorney about filing a separate claim for peritoneal adhesions if appropriate.

Impact: All levels - may support a separate compensable rating

Not bringing supporting records to the exam

Why: The examiner has a short window to document your condition. Without surgical records, lab results, or hospitalization documentation, findings may be based solely on your verbal report, which is more susceptible to challenge.

Do this instead: Bring operative reports, discharge summaries, recent labs (CBC, metabolic panel, vitamin levels), ostomy nursing notes, gastroenterology clinic notes, and any ER visit records.

Impact: All levels

Prep checklist

  • critical

    Obtain and review all surgical and operative records

    Request operative reports from the surgeon or hospital documenting the extent of resection (partial vs. total colectomy), type of anastomosis or stoma creation, whether the ileocecal valve was preserved or removed, and any complications during surgery.

    before exam

  • critical

    Track and document bowel movement or stoma output frequency for 2 weeks

    Keep a daily written log recording number of bowel movements or stoma evacuations, approximate volume, consistency, urgency, any accidents, and nocturnal episodes. Bring this log to the exam.

    before exam

  • critical

    Compile records of all IV hydration or hospitalization episodes in past 12 months

    Gather ER visit records, hospital admission/discharge summaries, and any infusion center records showing IV fluid administration for dehydration. Organize by date and confirm the exact count.

    before exam

  • critical

    Obtain recent laboratory results

    Get copies of your most recent CBC (hemoglobin, hematocrit, WBC, platelets), comprehensive metabolic panel (electrolytes, albumin), and vitamin/mineral levels (B12, iron, ferritin, vitamin D, calcium). These directly support nutritional deficiency and anemia findings.

    before exam

  • recommended

    Prepare a written summary of your condition history

    Write a one-to-two page summary covering: date of surgery, type of resection, reason for surgery, post-operative complications, current symptoms, medications, dietary restrictions, hospitalizations, and functional limitations. This helps ensure nothing is omitted during the exam.

    before exam

  • critical

    List all current medications including prescriptions, supplements, and infusions

    Include prescription anti-diarrheal medications (e.g., loperamide, cholestyramine), pain medications, prescribed nutritional supplements, oral rehydration solutions, vitamin/mineral prescriptions, biologic injections, and TPN or tube feeding regimens if applicable.

    before exam

  • recommended

    Weigh yourself and calculate your current BMI before the exam

    Know your current weight and height. Calculate your BMI (weight in kg divided by height in meters squared). If your BMI is below 18, this is directly relevant to rating thresholds. Track your weight trend since surgery.

    before exam

  • recommended

    Request a buddy statement from a caregiver, spouse, or close family member

    Ask someone who witnesses your daily symptoms to write a statement describing your bowel frequency, accidents, fatigue, stoma management needs, and functional limitations. Submit this to VA prior to the exam.

    before exam

  • optional

    Check your state's laws regarding exam recording rights

    Many states allow you to audio or video record your C&P exam with or without the examiner's consent. Research your state's one-party or two-party consent laws. If recording is permitted, bring a small recording device or use your phone.

    before exam

  • critical

    Do not minimize your symptoms on the day of the exam

    Your rating is based on your true, full symptom burden. If you are having a relatively good day during the exam, explicitly tell the examiner: 'Today is not typical - on my worst days, my symptoms are...' Describe both average and worst-day functioning.

    day of

  • critical

    Arrive with your bowel log, medication list, and supporting records organized

    Bring physical or digital copies organized by category (surgical records, lab results, hospitalization records, medication list, bowel diary). Offer them to the examiner and ask that they be reviewed as part of the exam.

    day of

  • recommended

    Plan for bathroom access needs at the exam location

    Locate restrooms at or near the exam facility before your appointment. Arrive early to reduce anxiety. If your condition requires it, alert the front desk that you may need restroom access during the wait. This also demonstrates your functional limitation to staff.

    day of

  • recommended

    Be prepared to describe your stoma or ostomy openly and accurately

    The examiner may ask to view your stoma site. Be prepared to show it and describe the condition of the peristomal skin, the appliance type, and any current complications. Do not be embarrassed - this is a medical examination and accurate documentation helps your claim.

    day of

  • critical

    Specifically state the type of resection (partial vs. total) and any stoma details

    Clearly tell the examiner: 'I had a [partial/total] colectomy on [date] and have a [permanent colostomy/permanent ileostomy/reanastomosis]. The ileocecal valve was [preserved/removed].' These are the structural foundation of your rating.

    during exam

  • critical

    Report the exact number of IV hydration episodes in the past 12 months

    State the number clearly: 'In the past 12 months I have required IV hydration [X] times.' Provide dates and locations. If the count exceeds 2, this is the critical threshold for the 100% rating and must be clearly documented.

    during exam

  • critical

    Describe functional impairment on work and daily activities in detail

    Tell the examiner specifically how your condition impacts your ability to work, including attendance issues, bathroom proximity requirements, urgency accidents, fatigue-related limitations, and any accommodations or job changes you have had to make.

    during exam

  • recommended

    Mention all complications including adhesions, fistulas, and systemic manifestations

    Do not wait to be asked about adhesions, dermatitis, anemia, hypocalcemia, low vitamin levels, lymph node enlargement, or other systemic findings. Proactively mention each one so the examiner can document it in the appropriate DBQ fields.

    during exam

  • recommended

    Request a copy of the completed DBQ or examination report

    You have the right to obtain a copy of your C&P examination results. Submit a written request to the VA regional office or check your Blue Button records in My HealtheVet or VA.gov after the exam is filed.

    after exam

  • critical

    Review the exam report for accuracy and completeness

    When you receive the exam report, check that the type of resection, stoma status, ileocecal valve status, diarrhea frequency, dehydration episode count, BMI, and functional limitations were all accurately documented. If information is missing or incorrect, notify your VSO or attorney immediately.

    after exam

  • recommended

    If the exam report is inadequate, request a new examination

    Under Barr v. Nicholson and related case law, if the exam is inadequate (e.g., fails to address all rating criteria, is based on an inaccurate history, or does not address functional impact), you or your representative can request a supplemental or new examination.

    after exam

Your rights during a C&P exam

  • You have the right to have the exam conducted in person. If a telehealth exam is proposed and you prefer an in-person exam, you may request one.
  • You have the right to request that your C&P exam be recorded (audio or video) in most states. Check your state's consent laws. Recording creates a verbatim record of what was said and protects against inaccurate documentation.
  • You have the right to submit a written statement before the exam describing your symptoms, functional limitations, and daily life impact. This becomes part of your claims file and the examiner should review it.
  • You have the right to review the completed DBQ examination report and to notify your VSO, accredited claims agent, or attorney if it contains inaccuracies or omissions.
  • You have the right to request a new or supplemental examination if the original examination is inadequate, based on an inaccurate history, or does not address all relevant rating criteria under DC 7329.
  • You have the right to submit a private medical nexus opinion or independent medical examination (IME) to supplement or rebut the VA examiner's findings.
  • You have the right to representation by a Veterans Service Organization (VSO), accredited claims agent, or attorney at no charge for claims representation at the regional office level.
  • You have the right to the benefit of the doubt under 38 U.S.C. - 5107(b) - when there is an approximate balance of positive and negative evidence regarding any issue material to the determination, VA must resolve the matter in the veteran's favor.
  • You have the right to file a Higher-Level Review or Board appeal if you disagree with the rating assigned following this examination.
  • Under the PACT Act, if your large intestine resection is connected to toxic exposure (e.g., Agent Orange, burn pits, radiation), you have additional rights to presumptive service connection. Ensure your examiner is aware of any relevant toxic exposure history.

Get a personalized prep packet

This guide covers what to expect for any veteran with this condition. If you have already uploaded your medical records, sign in to generate a packet that maps your specific symptoms to the DBQ fields your examiner will fill out.

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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.